What to Know Before You Go to the Hospital

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No one enjoys going to the hospital, but sometimes it’s a necessity. A hospital stay means a loss of your independence and submitting yourself to being in a different environment on a different schedule than your normal routine. If you have a condition that can be better managed in a setting where you have access to 24/7 medical professionals, then going to the hospital is a no-brainer. Having pain shooting through your right groin area, only to find out that you have a ruptured appendix, warrants a trip to the hospital for an appendectomy (removal of the appendix) and then monitoring to make sure you do not have complications such as a blood infection known as sepsis. If a medical professional tells you that treatment for your condition should occur in a monitored environment such as a hospital, then you probably should go. If you are unsure, you can always get a second opinion—if it’s not an emergency. Doctors generally do not like to send their patients to the hospital as a rule if they can be treated in an alternative setting. Many times your doctor may not be the one in charge of your care in the hospital. It may be a hospitalist who oversees your care. A hospitalist is a doctor who specializes in caring for patients in a hospital setting. The hospitalist will study your chart to learn your history but will not know you as well as your attending doctor, so communication with the hospitalist will be key. Ask your doctor if they will be overseeing your care or using a hospitalist. If your appendix was inflamed and hadn’t ruptured, you may be sent to an ambulatory surgical center (ASC) where it can be removed and you can go home to recover. That would be one way to have an appendix removed. If your doctor is suggesting that you go to the hospital, talk to the doctor about other options such as an ASC. If you have the luxury of time, meaning your hospital stay isn’t an emergency, research your condition to better understand what you can expect during your hospital stay. This will also decrease your anxiety about being outside your home environment and let you know exactly what to expect during your hospital stay. The internet is like the wild west when it comes to medical advice. You should start with reputable sites such as WebMD https://www. webmd.com/. There are also site-specific websites depending on your condition. One good example is facty.com, which describes the procedure you are having done. For a cardiac catheterization, they inform you that the interventional cardiologist will be inserting a catheter through a large artery to diagnosis your heart problem and may even place stents to open clogged arteries and allow blood to flow to your heart more rapidly. The more you know about your condition and what to expect at a hospital the better partner you will be to your health care team. 



Most patients think that their doctor will be caring for them in the hospital setting. Usually, the duties are assigned to a hospitalist. Ask your doctor how he will be monitoring your health and receiving information if he is working with a hospitalist. Be specific, ask the doctor how often he will be communicating with the hospitalist, as your doctor understands your health care situation the best. Ask if they will talk by phone (preferred) or if he will be getting daily reports. Keep your doctor involved in your care.



Choosing the Hospital 

Choosing your hospital and your physician are especially important steps if you must go to the hospital. There are all kinds of data out there that will let you know how your hospital fares as compared to the national benchmarks. National benchmarks are standards that the Centers for Medicare & Medicaid Services (CMS) have set for issues like infection rates and never events. A never event is something that CMS believes should never occur under any situation in health care. There is a wealth of data located at Data.Medicare.gov, which can be accessed at the following link https://data.medicare.gov/ 2 This is best accessed from a personal computer or laptop. Simply click on the https://www.medicare.gov/care-compare/ button below the word “search” to get started. The hospital in my emergency department story, which we will discuss later, was only rated two stars out of five, and having experienced care there, I now know why. The data allows you to compare hospitals, compare physicians, and even compare long-term care centers. This is important because unless you do your research you could end up being sicker when you come out of the hospital than when you went in. It is worth your time to look at a hospital’s infection rate. For instance, if you’re going in for a surgical procedure and you see that a hospital’s infection rate is worse than the rest of the country, and you discover the surgeon who’s going to perform the surgery on you has a high infection rate, you probably want to look for another hospital and another surgeon. A little-known fact outside the medical community is while your surgeon works on you in the operating room, it is the anesthesiologist who is charged with keeping you alive. But as with most things in health care, this is complex, as your anesthesiologist may not be in the room during your surgery. Instead, the anesthesiologist may be overseeing a Certified Registered Nurse Anesthetist (CRNA), which isn’t necessarily bad, but you should know so you can assemble the best health care team to make sure you receive the optimal care. Remember, you are hiring these experts to look after you during a time in which you will not be conscious or able to weigh in on their decisions, so do your homework and gather as much information as possible. Ask the anesthesiologist if they will be doing the procedure or if it will be a CRNA. You want to know who is keeping you alive during your surgery. One way to ensure you are hiring quality individuals on your medical team is to use the Data.Medicare.gov site to look up your anesthesiologist or any team member by asking in advance for their name.


Do Your Research 

Like anything else you will encounter in life, some people in health care excel at what they do and some do not. The difference is those who do not excel in taking care of their patients can cause harm. While hiring a bad plumber may cause some water damage in your house, hiring a bad surgeon can cost you a long recovery time or possibly even death. The typical patient does not understand they have total control over which doctor cares for them. Sure, there are barriers such as the doctor being in their health insurance network, which means they will pay less out of pocket money, but if you have a doctor who is outside of your network and is the best at what they do, they may be worth the additional expense. When you are a nurse at a hospital, you pretty much know what surgeons or doctors you would allow to care for your family. That is a huge advantage because you have seen their mistakes and you have seen good outcomes. Many patients do not have this firsthand experience. I can remember one time when I was out grocery shopping, I overheard two women having a conversation. One announced to the other, “Oh yes, I’m going to the hospital Monday, and doctor so and so is going to operate on me.” Now, I had taken care of this doctor’s patients, and many of them did not do well after their surgeries. There was a marked difference between other surgeon’s patient outcomes and this particular surgeon’s patient outcomes. In other words, this was a surgeon I would not let come within 100 feet of myself or any of my family members. Finding a good, honest mechanic is something we all try to do. This is much more important when choosing a surgeon, doctor, or hospital. In the medical community poor performing people sometimes are allowed to continue to practice. That is why hospital systems are moving from getting paid for the number of patients they see to getting paid on the patients’ quality outcomes. My conscience bothered me as I continued to shop in the store. I struggled, asking myself if it would be ethical for me to say something to this woman and if so, I could not tell her who I am. Lo and behold, this woman appeared with her grocery cart coming down the same aisle I was in. I always believe in doing what is right and took this as a sign, so as she came down the aisle I spoke softly, “I couldn’t help but overhear your conversation about your operation that you are having Monday. I can’t tell you who I am, but I am going to tell you that you should change your surgeon.” She looked at me wide-eyed and I responded, “I can’t say anymore, but I work at the hospital, and you should find a different doctor.” As I started to walk away I heard her say thank you. It is so important to do your research on your physician and your hospital. If you do not do your research, you may risk putting yourself in a precarious situation. 


Do your research! You wouldn’t buy a car without checking on its safety rating or researching how much you would pay for the car. Health care should be no different. Find the best hospital and doctor in your area. This will give you much better odds of having a safe experience and get you on to the road to recovery.




Most patients are under the assumption that the health care team consults with each other on the patient’s care, but that is not always the case. Medications are a huge part of your care, and safely administering them, plus reconciling them with your other drugs when the doctor orders new medications, is when many errors occur. Reconciling medications is usually done in the electronic medical record (EMR) system by a doctor. It happens when you are admitted, change a venue of care such as going from surgery to a unit bed, and upon discharge. This process was carried out badly when medical personnel still used paper, and the automation of this process isn’t much better. It’s very important because you want to be getting the correct dose, the correct medication, and the correct way the medication should be administered. For instance, when you have surgery, many times the surgeon does not want to reconcile your daily medications. Instead, they want to just order what you need in the recovery period and let your attending doctor or hospitalist write orders for your daily medications. Sometimes the recovery nurse doesn’t discontinue your recovery medications, and they follow you to the next venue of care, such as the inpatient floor. Behind the scenes, medication management in the hospital can be a disaster. One thing you can do to avoid an issue is pack up all your medications before going to the hospital. A better practice is listing your medications in a computer file and printing off multiple copies. Give each caregiver that you interact with—doctor, nurse, anesthesiologist, etc.—a copy of your medications. Do not assume that your team is communicating with each other about your medications. Take control of this situation and communicate the medications that you take, including any supplements. I had an uncle who had phosphorus problems and hospitals did not stock his medications all the time, so he simply brought his medications from home when he had to go to the hospital. The hospital pharmacy disliked this, as they have to go through a rigorous process to verify the medications. But at the end of the day, it’s not about what the pharmacy likes or doesn’t like; it’s all about keeping you safe. This is an option that many patients do not know they have. If you are going to be admitted to the hospital, bring in your home medications and request they be used instead of medications from the pharmacy. It may even save you some money. Health care in this country is moving away from an approach in which we provide care to the patients in a top-down fashion. What I mean by that is in the past the physician was the keeper of all knowledge, and there was little input from patients. That is changing as patients do their research, using the Internet, and start to ask questions. This new approach allows you as a patient to have a say in your health care. Using the knowledge you have gained from this chapter will help you safely navigate the healthcare system and be in better control of your care. Although you will be out of your normal element, you can still retain control of key factors like hiring the best possible health care team, choosing a hospital that delivers quality care, and managing your medications. Research is key as well as communication with your health care team to ensure you have an optimal experience while in the hospital. While it’s rare that someone looks forward to going to the hospital, an informed patient can provide themselves a degree of safety that an uninformed patient cannot. 



Medication management is crucial. If an error occurs in a hospital, it usually concerns medication administration. Bringing in a list of your current medications is important but having your nurse read back to you the medications listed in the electronic medical record (EMR) is very important. If you change venues of care, such as going to surgery and then to an inpatient room, the first thing you should do is ask your nurse to read your medications back to you from the EMR to ensure they are correct.


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